43 A Model of Interdisciplinary Working to Enhance the Care of Residential Home Patients

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i11-i13
Author(s):  
E Goodwin ◽  
T Bacarese-Hamilton ◽  
A Steel ◽  
A Patel
Keyword(s):  
Mental Health ◽  
Clinical Skills ◽  
Care Home ◽  
Psychological Needs ◽  
Professional Relationships ◽  
Residential Home ◽  
Clinical Frailty Scale ◽  
Home Setting ◽  
Care Home Staff ◽  
Care Plans

Abstract Introduction 291,000 patients in the UK live within the care home setting. The King’s Fund reports that the average residential home patient is an 85-year-old female with a 12-30 month life expectancy. Care needs are complex with six or more diagnosed conditions, seven or more prescribed medications and a combination of physical frailty, disability and mental health conditions. In line with the NHS Long Term plan 2019 the Care Home project sought to promote ageing well through interdisciplinary working. Aims Provide cost neutral interdisciplinary review of care home residents Review the medication of all residents Review resuscitation status and initiate anticipatory care plans for appropriate residents To further the education and professional relationships across primary, secondary and mental health interface. Reduction of transitions between care settings for residents. Methods 12 sessions in 1 care home over a year (2018-2019) Team consisted of GPs, Geriatric Registrars, Old Age Psychiatry Registrar, care home staff and CCG pharmacist 2-4 patients per session chosen on the basis of complex physical and/or psychological needs Format of session consisted of: o Pre-assessment discussion of patient o Interdisciplinary patient review o Debriefing and formulation of management plan Sessions concluded with teaching from the different disciplines. Results We reviewed 25 residents with an average Clinical Frailty Scale score of 7. 100% patients had a medication and psychiatric review. 100% had review of DNAR status with 40% increase in DNAR forms completed. There was a 60% increase in anticipatory care plans initiated. There was a reduction in acute admissions from the care home with a resultant cost saving of over £45,000. 100% of participants would strongly recommend the project and reported improved relationships. 90% of care home staff thought the project was beneficial to the residents and staff felt more supported. Conclusions Interdisciplinary working within the patient’s own setting provides patient centred care, promotes sharing of professional expertise, enhances clinical skills and builds professional relationships. This model of project is easily scalable and is a cost-effective way of providing high quality care for patients in their own residence.

462 COUNSELLING IN CARE HOMES

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii1-ii4
Author(s):  
J Pybis ◽  
N Chigariro ◽  
J Bacon
Keyword(s):  
Mental Health ◽  
Service Delivery ◽  
Care Home ◽  
Poor Mental Health ◽  
Care Homes ◽  
Structured Interviews ◽  
Home Setting ◽  
Care Home Staff ◽  
People With Dementia ◽  
Mental Health Foundation

Abstract Introduction Although many people live well within care homes, it is estimated that 60% of those living in residential care have poor mental health (Age Concern & Mental Health Foundation, 2006) and 40% suffer from depression (The Royal College of General Practitioners, 2014). Antidepressant prescribing has been reported to be nearly four times greater in care homes than for older people living in the community (Harris, Carey, Shah, Dewilde & Cook, 2012). However, antidepressants have been found to be ineffective for people with dementia (Dudas, Malouf, McCleery & Dening, 2018). With two-thirds of care home residents having some form of dementia, there is a need to find alternative interventions. Talking therapies, such as counselling, may be a useful alternative. Method Adopting a qualitative approach using semi-structured interviews and focus groups with counsellors (N = 12) who have experience of working in this context and with care home managers (N = 3) and care teams (N = 6), this study aimed to explore the feasibility of implementing counselling in a care home setting. We explored the views of care home staff towards counselling and identify barriers to service implementation, alongside the experience of counsellors who have delivered counselling in care homes to understand what service delivery models are currently adopted. Data were analysed thematically. Results Findings fell under the following key themes: The funding and referral process for counselling in a care home; skills and competences required; training needs; adaptations to practice; barriers to implementing counselling in a care home. Conclusions It is timely to consider the role of psychological therapy in supporting the mental health of care home residents. There is a need for further research to explore a service delivery model of counselling in care homes.

scholarly journals Optimising Medication Use along Dementia Progression: Recommendations from a Qualitative Study

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 982
Author(s):  
Dalal Alsaeed ◽  
Mine Orlu ◽  
Felicity Smith
Keyword(s):  
Family Caregivers ◽  
Caregiver Burden ◽  
Information Needs ◽  
Care Home ◽  
Medication Use ◽  
Medicines Management ◽  
Home Setting ◽  
Face To Face ◽  
Care Home Staff ◽  
Telephone Interviews

Medicines management is known to be an integral part of the role of family caregivers; it also contributes to the burden and stress of caregivers’ experience. As dementia progresses, new challenges arise as a consequence, which negatively affects the ability of people living with dementia (PLWD) regarding practical decision making and may lead to a change of setting. The aim of this study is to identify and explore changes in medicines management and associated caregiver burden as dementia progresses. To examine medicines management and related issues across severities, a qualitative approach utilising face-to-face and telephone interviews with PLWD and their family caregivers in both the community and care-home setting in London was used. Follow-up interviews with family caregivers were also conducted to gain additional insight into change over time. Eleven family caregivers, ten PLWD, and eight care-home staff were interviewed in 2016. Findings identified how key changes along dementia progression affect medication use. These include changes to caregiver burden, respecting the PLWD’s autonomy and decline in capacity, scheduling and administration, choice of formulation, interactions with and between providers, and information needs. The findings assist in informing recommendations to optimise medication use and alleviate caregiver burden.

PP102 Developing A Contextually-Informed Deprescribing Intervention

2018 ◽  
Vol 34 (S1) ◽  
pp. 104-105
Author(s):  
Charlene Ronquillo ◽  
Ken Stein
Keyword(s):  
Health Care Professionals ◽  
Care Home ◽  
Stakeholder Involvement ◽  
Care Homes ◽  
Successful Implementation ◽  
Allied Health Professionals ◽  
Home Setting ◽  
Stakeholder Consultation ◽  
Care Home Staff ◽  
Local Stakeholder

Introduction:Deprescribing – a process for reducing or stopping drugs when the balance of benefits and harms may no longer be in a person's interests – is a key aspect of managing multimorbidity and polypharmcacy in older people. Several deprescribing interventions have been developed (e.g. in Australia and Canada), although significant challenges for successful implementation remain. Through key stakeholder consultation in the care home setting in South West England, we take the initial steps to develop a context-informed deprescribing approach. Engaging stakeholders from the outset gains insight into acceptability, feasibility, and relevance of deprescribing interventions developed elsewhere informing co-production of an effective, implementable approach.Methods:Consultation workshops were held with two groups of stakeholders: (i) care home residents and their families; (ii) care home staff and health care professionals (general practitioners, medical specialists, pharmacists, nurses, allied health professionals). Focus groups were held with each group separately to understand perspectives on: deprescribing in general; contextual considerations; and, perspectives on deprescribing interventions developed in other countries. A combined focus group then considered components of a deprescribing intervention for care homes. Qualitative data were audio recorded, transcribed, and thematically coded.Results:Participants described the nature of local relationships, dynamics, structures, and resources, as important considerations in the development of a deprescribing approach in care homes. Perspectives and concerns around deprescribing among the stakeholder groups varied, although the importance of eliciting local stakeholder feedback in the early stages of developing a deprescribing intervention was a common thread.Conclusions:Early engagement and co-production are crucial in developing an approach to deprescribing in care homes. The combination of stakeholder involvement and qualitative research is important for developing an effective, contextually relevant intervention as the balance between interests can be incorporated into the approach. Leveraging the experience in other countries is a novel and valuable step.

scholarly journals National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

2014 ◽  
Vol 2 (4) ◽  
pp. 1-480 ◽  
Author(s):  
David Challis ◽  
Sue Tucker ◽  
Mark Wilberforce ◽  
Christian Brand ◽  
Michele Abendstern ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Older People ◽  
Mental Health Problems ◽  
Care Home ◽  
Research Programme ◽  
Community Services ◽  
Care Homes ◽  
Care Home Staff ◽  
Mental Health Outreach

BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

scholarly journals Implementation of the National Early Warning Score in UK care homes: a qualitative evaluation

2020 ◽  
Vol 70 (700) ◽  
pp. e793-e800
Author(s):  
Siân Russell ◽  
Rachel Stocker ◽  
Robert Oliver Barker ◽  
Jennifer Liddle ◽  
Joy Adamson ◽  
...  
Keyword(s):  
Early Warning ◽  
Care Home ◽  
Qualitative Evaluation ◽  
Acute Illness ◽  
Care Homes ◽  
Early Warning Score ◽  
Normalisation Process Theory ◽  
Home Setting ◽  
Care Home Staff ◽  
National Early Warning Score

BackgroundThe National Early Warning Score (NEWS) is a tool for identifying and responding to acute illness. When used in care homes, staff measure residents’ vital signs and record them on a tablet computer, which calculates a NEWS to share with health services. This article outlines an evaluation of NEWS implementation in care homes across one clinical commissioning group area in northern England.AimTo identify challenges to implementation of NEWS in care homes.Design and settingQualitative analysis of interviews conducted with 15 staff members from six care homes, five health professionals, and one clinical commissioning group employee.MethodInterviews were intended to capture people’s attitudes and experiences of using the intervention. Following an inductive thematic analysis, data were considered deductively against normalisation process theory constructs to identify the challenges and successes of implementing NEWS in care homes.ResultsCare home staff and other stakeholders acknowledged that NEWS could enhance the response to acute illness, improve communication with the NHS, and increase the confidence of care home staff. However, the implementation did not account for the complexity of either the intervention or the care home setting. Challenges to engagement included competing priorities, insufficient training, and shortcomings in communication.ConclusionThis evaluation highlights the need to involve care home staff and the primary care services that support them when developing and implementing interventions in care homes. The appropriateness and value of NEWS in non-acute settings requires ongoing monitoring.

Perceptions of care home staff on the effect of the care home environment for individuals living with dementia

2015 ◽  
Vol 19 (2) ◽  
pp. 69-76 ◽  
Author(s):  
Sally Dawn Boyden
Keyword(s):  
Social Interaction ◽  
Literature Review ◽  
Home Environment ◽  
Care Home ◽  
Home Setting ◽  
Content Type ◽  
Care Home Staff ◽  
People With Dementia ◽  
The Impact ◽  
Staff Involvement

Purpose – The purpose of this paper is to explore what existing literature about the care home environment for people with dementia reveals. It also evaluates the implications for practice, to show which parts of the care home environment staff feel have the most impact on the day to day lives of residents living with dementia. In turn, this paper seeks to feedback to care home management to improve practice and to contribute to research in care homes in the future. Design/methodology/approach – A literature review forms the basis of this research, in addition to four semi-structured interview conducted with care home staff of different roles; allowing them to share their experiences with little restriction. Participants were recruited through informal discussions with the researcher before the research took place, as part of her job role and using purposive sampling. Findings – Data were analysed using computer software Nvivo and identified four main categories which all participants discussed: social interaction, staff involvement, staff restrictions, staff involvement and physical elements of the environment. This research has shown the importance of staff presence in the care home environment to facilitate social interaction among residents with dementia. Research limitations/implications – The sample is very small due to staff not having the time to take part in the interview and this itself is a key finding. Interviews were able to capture feelings but not the overall experience of interaction between resident and staff, which observations would have achieved if there was more time to conduct the research. Originality/value – A literature review and qualitative research signifying the importance of staff presence in the care home setting in order for the residents to socially engage in their environment. However, it has also show the lack of time that is face by staff and the impact this has on people living with dementia.

scholarly journals Provision of training for accommodation providers in the London Borough of Hackney – results of a scoping exercise and educational session pilot

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S122-S123
Author(s):  
Kate Aldersey ◽  
Sheraz Ahmad ◽  
Sian Mason
Keyword(s):  
Mental Health ◽  
Care Home ◽  
Healthcare Providers ◽  
Support Worker ◽  
Rehabilitation Team ◽  
London Borough ◽  
Care Home Staff ◽  
Mental Health Awareness ◽  
Mental Health Settings ◽  
Level Of Training

AimsTo understand the level of training given to staff in providers of accommodation in the London Borough of Hackney across mental and physical health.MethodThe Urgent and Emergency Care Collaborative (Health Education England) put out a call for funding bids around a number of workforce priority areas. This included upskilling care home staff to reduce admissions. We considered care home staff as those working across supported living schemes, housing with care, residential and nursing homes. Some of these settings exclusively support people with mental health needs.We obtained a list of accommodation providers across the borough via the Local Authority. As a Community Rehabilitation team we work closely with many of the providers. We also co-facilitate the Hackney Mental Health Supported Accommodation panel and review all funded placements annually. We made contact via email and phonecall and arranged face to face meetings with 11 providers. We asked a standard set of questions about the organisation and training provision. We also asked them to identify gaps in training.ResultThe level of training provided to staff varies vastly across different settings. There was a predominance of e-learning for some providers. Most staff in mental health settings are support worker level which limits the level of training offered/received.Providers varied greatly in size of project and management structure and this directly impacts on access to training, often as a result of cost.Providers were able to identify training gaps and were keen to have additional training.Some common themes emerged – dual diagnosis, psychosis, medication – and some setting specific themes – dementia.Based on the gaps identified we provided training sessions to a total of ~40 staff across a number of settings. Content included mental health awareness, crisis signposting and medicines management. All sessions were well received with pre and post-training questionnaires demonstrating an improvement in knowledge and confidence.ConclusionThere is potential for knowledge sharing across accommodation settings and for stronger links between accommodation providers and healthcare providers. We plan to explore the possibility of quantitative data on the number of Emergency Department presentations from accommodation settings locally.

scholarly journals Medical Crises in Older People: cohort study of older people attending acute medical units, developmental work and randomised controlled trial of a specialist geriatric medical intervention for high-risk older people; cohort study of older people with mental health problems admitted to hospital, developmental work and randomised controlled trial of a specialist medical and mental health unit for general hospital patients with delirium and dementia; and cohort study of residents of care homes and interview study of health-care provision to residents of care homes

2015 ◽  
Vol 3 (4) ◽  
pp. 1-410 ◽  
Author(s):  
John Gladman ◽  
Rowan Harwood ◽  
Simon Conroy ◽  
Pip Logan ◽  
Rachel Elliott ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Cohort Study ◽  
Randomised Controlled Trial ◽  
Older People ◽  
Controlled Trial ◽  
Care Home ◽  
Cost Effective ◽  
Care Home Staff ◽  
Randomised Controlled

BackgroundThis programme of research addressed shortcomings in the care of three groups of older patients: patients discharged from acute medical units (AMUs), patients with dementia and delirium admitted to general hospitals, and care home residents.MethodsIn the AMU workstream we undertook literature reviews, performed a cohort study of older people discharged from AMU (Acute Medical Unit Outcome Study; AMOS), developed an intervention (interface geriatricians) and evaluated the intervention in a randomised controlled trial (Acute Medical Unit Comprehensive Geriatric Assessment Intervention Study; AMIGOS). In the second workstream we undertook a cohort study of older people with mental health problems in a general hospital, developed a specialist unit to care for them and tested the unit in a randomised controlled trial (Trial of an Elderly Acute care Medical and mental health unit; TEAM). In the third workstream we undertook a literature review, a cohort study of a representative sample of care home residents and a qualitative study of the delivery of health care to care home residents.ResultsAlthough 222 of the 433 (51%) patients recruited to the AMIGOS study were vulnerable enough to be readmitted within 3 months, the trial showed no clinical benefit of interface geriatricians over usual care and they were not cost-effective. The TEAM study recruited 600 patients and there were no significant benefits of the specialist unit over usual care in terms of mortality, institutionalisation, mental or functional outcomes, or length of hospital stay, but there were significant benefits in terms of patient experience and carer satisfaction with care. The medical and mental health unit was cost-effective. The care home workstream found that the organisation of health care for residents in the UK was variable, leaving many residents, whose health needs are complex and unpredictable, at risk of poor health care. The variability of health care was explained by the variability in the types and sizes of homes, the training of care home staff, the relationships between care home staff and the primary care doctors and the organisation of care and training among primary care doctors.DiscussionThe interface geriatrician intervention was not sufficient to alter clinical outcomes and this might be because it was not multidisciplinary and well integrated across the secondary care–primary care interface. The development and evaluation of multidisciplinary and better-integrated models of care is justified. The specialist unit improved the quality of experience of patients with delirium and dementia in general hospitals. Despite the need for investment to develop such a unit, the unit was cost-effective. Such units provide a model of care for patients with dementia and delirium in general hospitals that requires replication. The health status of, and delivery of health care to, care home residents is now well understood. Models of care that follow the principles of comprehensive geriatric assessment would seem to be required, but in the UK these must be sufficient to take account of the current provision of primary health care and must recognise the importance of the care home staff in the identification of health-care needs and the delivery of much of that care.Trial registrationCurrent Controlled Trials ISRCTN21800480 (AMIGOS); ClinicalTrials.gov NCT01136148 (TEAM).FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 3, No. 4. See the NIHR Journals Library website for further project information.

scholarly journals Health care needs of older people living permanently in a residential home setting in Gauteng

Curationis ◽  
2003 ◽  
Vol 26 (4) ◽  
Author(s):  
MM Chabeli
Keyword(s):  
Health Care ◽  
Elderly People ◽  
Psychological Needs ◽  
Health Needs ◽  
Residential Home ◽  
Data Sets ◽  
Health Care Needs ◽  
Care Needs ◽  
Home Setting ◽  
Interview Session

This article reviews some of the prevailing health needs of elderly people living permanently in a residential old age home. A qualitative, exploratory and descriptive design was employed. Twenty-one black elderly people were purposively selected to participate in a focus group interview session for the purpose of describing their perception of their health care needs. From descriptive content analysis, three main data sets emerged, namely physical health needs, unmet psychological needs and the need for a healthy social relationship. Recommendations to deal with these health needs were made based on the empirical data supported by literature. Measures of trustworthiness were ensured as described by Lincoln and Guba (1985:316-327).

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